Northern Territory Child Deaths Review and

Prevention Committee

The NT Child Deaths Review and Prevention Committee respects the beliefs of Aboriginal and Torres Strait Islander people and advises there is information in this report regarding deceased Aboriginal and Torres Strait Islander children.

Office of the Children’s Commissioner, Northern Territory PO Box 40598 Casuarina NT 0811 Telephone 08 8999 6076 Facsimile 08 8999 6072 E-mail childrenscommissioner@nt.gov.au

www.childrenscommissioner.nt.gov.au

© Office of the Children’s Commissioner, Northern Territory Government, 2014

This work is copyright belonging to the Northern Territory of Australia and is subject to conditions of the Copyright Act 1968 and the Northern Territory copyright policy.

The information in this report may be freely copied and distributed for non-profit purposes such as study, research, services management and public information subject to the inclusion of an acknowledgement of the Child Deaths Review and Prevention Committee, Northern Territory as the source.

ISSN 1837-3852 Printed by: Uniprint

Suggested citation

CDRPC (2014). Annual Report 2013-2014, Northern Territory Child Deaths Review and Prevention Committee, Office of the Children’s Commissioner, Darwin.

This Report is available in electronic format at: www.childrenscommissioner.nt.gov.au

The Honourable John Elferink MLA

Minister for Children and Families

Parliament House

Mitchell Street

DARWIN NT 0801

Dear Minister

In accordance with Part 3.3, section 213 of the Care and Protection of Children Act 2007, I am

pleased to provide you with the Annual Report of the Northern Territory Child Deaths Review

and Prevention Committee for 2013 - 2014.

Yours sincerely,

Dr Howard Bath

Convenor

NT Child Deaths Review and Prevention Committee

31 October 2014

Table of contents

Table of contents .................................................................................... 5

List of tables............................................................................................ 7

List of Appendices .................................................................................. 8

Northern Territory Child Deaths Review and Prevention Committee ... 9

Glossary of terms ................................................................................. 11

Definitions ............................................................................................. 12

Foreword ............................................................................................... 14

Executive summary .............................................................................. 15

Background and overview of the Committee activities ..................... 15

Issues relating to child deaths data in the NT .................................... 15

Child deaths in the NT, 2009-13 ........................................................... 16

2013 snapshot ....................................................................................................... 16

2009-13 aggregate snapshot ................................................................................. 16

Research ............................................................................................... 17

CHAPTER 1 ........................................................................................... 18

Introduction ........................................................................................... 18

Background ............................................................................................................ 18

Legislation .............................................................................................................. 18

Roles and functions of the Committee ................................................................... 18

Structure and membership of the Committee ........................................................ 19

Provision of information to the Committee ............................................................. 20

The Child Deaths Register ..................................................................................... 20

Activities of the Committee .................................................................................... 20

Audit of Child Death Register ............................................................................ 20

Research ............................................................................................................... 21

Research into SUDI deaths 2006-12 ................................................................. 21

Literature reviews .............................................................................................. 21

Update on the 2011 research into suicide deaths of children and young people .......................................................................................................................... 21

National representation and engagement .......................................................... 22

CHAPTER 2 ........................................................................................... 23

Issues relating to child death data in the Northern Territory............. 23

Sources of data on child deaths .......................................................... 23

Australian Bureau of Statistics ........................................................................... 23

Registry of Births, Deaths and Marriages .......................................................... 23

Office of the NT Coroner ................................................................................... 23

The National Coroner’s Information System ...................................................... 24

Other sources of data ........................................................................................ 24

Confidentiality of information .................................................................................. 24

Coding cause of death ........................................................................................... 24

Calendar year reporting ......................................................................................... 25

CHAPTER 3 ........................................................................................... 26

Child deaths in the Northern Territory ................................................ 26

Child deaths in 2013 .............................................................................................. 26

Child deaths, 2009-13 ............................................................................................ 27

Child deaths by year, Aboriginal status and age group, NT, 2009-13 .................... 28

Child deaths by usual residence, age group, gender and Aboriginal status, NT, 2009-13 .................................................................................................................. 29

Infant deaths, 2009-13 ........................................................................................... 30

Stillbirths, 2009-13 ................................................................................................. 30

Neonatal deaths, 2009-13 ...................................................................................... 31

Perinatal deaths, 2009-13 ...................................................................................... 31

Post-neonatal deaths, 2009-13 .............................................................................. 32

Child death rates .................................................................................................... 33

Deaths of children with a family involvement in child protection services 2009-13 ... 34

CHAPTER 4 ........................................................................................... 37

Underlying causes of child deaths in the Northern Territory, 2009-13 .. 37

Underlying cause of death by year, NT, 2009-13 ................................................... 38

Underlying cause of death by gender and Aboriginal status, NT, 2009-13 ............ 40

Underlying cause of death by ICD-10 chapter and usual residence, NT, 2009-13 ... 43

Underlying cause of death by chapter and age group, NT, 2009-13 ...................... 44

CHAPTER 5 ........................................................................................... 46

Research ............................................................................................... 46

Literature Reviews ................................................................................................. 46

Update on intentional self-harm deaths of NT children, 2011-13 ........................... 46

Background ....................................................................................................... 46

The follow-up review .......................................................................................... 47

Key points from the review ................................................................................ 51

References ............................................................................................ 52

List of tables Table 1: Number of child deaths by age group and gender, NT, 2013 .................................... 27

Table 2: Child deaths by year, gender and age group, NT, 2009-13 ...................................... 27

Table 3: Child deaths by year, Aboriginal status and age group, NT, 2009-13 ....................... 28

Table 4: Child deaths by usual residence, age group, gender and Aboriginal status, NT, 2009-13 ................................................................................................................. 29

Table 5: Infant deaths by gender and Aboriginal status, NT, 2009-13 .................................... 30

Table 6: Stillbirths by Aboriginal status and year, NT, 2009-13 .............................................. 31

Table 7: Neonatal deaths by year and Aboriginal status, NT, 2009-13 ................................... 31

Table 8: Perinatal deaths by type, Aboriginal status and year, NT, 2009-13 ........................... 32

Table 9: Post neonatal infancy by Aboriginal status and year, NT, 2009-13 ........................... 32

Table 10: Child death rates by year, NT, 2009-13 .................................................................. 33

Table 11: Child death rates by age-group, NT, 2009-13 ......................................................... 34

Table 12: Child death rates by age group and gender, NT, 2009-13 ...................................... 34

Table 13: Characteristics of child death by known to DCF status, NT, 2009-13...................... 36

Table 14: Underlying cause of child death by ICD-10AM chapter, NT, 2009-13 ..................... 37

Table 15: Underlying cause of death by ICD-10 chapter and year, NT, 2009-13 .................... 38

Table 16: Underlying cause of death by ICD-10 chapter, gender and Aboriginal status, NT, 2009-13 .................................................................................................................. 40

Table 17: Underlying cause of death by ICD-10 Chapter and usual residence, NT, 2009-13 . 43

Table 18: Underlying cause of death by ICD-10 chapter and age-group, NT, 2009-13 ............. 45

Table 19: Distribution of child and adult intentional self-harm deaths by Aboriginal status and usual residence, for audited cases, NT, 2006-10 ................................................... 48

Table 20: Distribution of child and adult intentional self-harm by Indigenous status and usual residence, for audited cases, NT, 2011-13 ............................................................. 48

Table 21: Child deaths by intentional self-harm by gender and age group, NT, 2011-13 ............. 49

Table 22: Adult deaths by intentional self-harm, NT, 2011-13 ................................................ 50

List of figures

Figure 1: Number of child deaths by age group, NT, 2013 ..................................................... 26

Figure 2: Proportion of child deaths and population by usual residence, NT, 2009-13 ............... 30

Figure 3: Child death rates by year, NT, 2009-13 ................................................................... 33

Figure 4: Number of child deaths by ‘known/ not known to DCF’ status, NT, 2009-13 .............. 35

Figure 5: Underlying cause of death by ICD-10 chapter and gender, NT, 2009-13 ................. 41

Figure 6: Underlying cause of death by ICD-10 chapter and Aboriginal status, NT, 2009-13.. 42

Figure 7: Underlying cause of death by ICD-10 chapter and usual residence, NT, 2009-13 ... 44

Figure 8: Child deaths by intentional self-harm, NT, 2006-13 ................................................. 50

List of Appendices Appendix 1: Northern Territory of Australia Care and Protection of Children Act Part 3.3

Prevention of Child Deaths ..................................................................................... 53

Appendix 2: Infant mortality rate by Aboriginal status and year, NT, 1992–12 ........................ 60

Appendix 3: Table of underlying cause of child deaths by ICD-10 chapters, NT, 2009-13 .................................................................................................................. 61

Appendix 4: The historical context of NT data on child deaths ............................................... 65

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Northern Territory Child Deaths Review and Prevention Committee

Members as at 30 June 2014

Dr Howard Bath Convenor, NT Child Deaths Review and Prevention Committee Children’s Commissioner, NT

Ms Kathryn Ganley Deputy Convenor, NT Child Deaths Review and Prevention Committee Deputy Coroner, Office of the NT Coroner, NT

Ms Vicki Baylis Executive Director, School Education and Early Childhood Services, Department of Education and Training, NT

Commander Richard Bryson Commander, Crime and Specialist Support Command NT Police, Darwin, NT

Ms Priscilla Collins Director, North Australian Aboriginal Justice Agency (NAAJA) Darwin, NT

Dr Steve Guthridge Director, Health Gains Planning, Department of Health, NT

Dr Charles Kilburn Co-Director, Division Maternal and Child Health and Medical Director Special Care Nursery, Royal Darwin Hospital, Department of Health, NT

Professor Victor Nossar Program Leader, Child and Youth Health, Health Development, Department of Health, NT

Associate Professor Robert Parker Director of Psychiatry, Top End Mental Services, Department of Health, NT

Dr Barbara Paterson Chief Health Officer and Executive Director for Health Protection, Department of Health, NT

Dr Geoff Stewart Maningrida Community Health Service, NT. Department of Health, NT

Ms Leonie Warburton Senior Manager, Quality and Practice Framework Department of Children and Families, NT

Dr Jo Wright Senior Director, Alcohol and Other Drugs Program, Strategy and Reform Department of Health, NT

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Mr Peter Pangquee Principal Aboriginal and Torres Strait Islander Health Practitioner Advisor Department of Health, NT

Past Member of the Committee (2012–13)

Ms Josie Crawshaw Chief Executive, Stronger Aboriginal Families Together (SAFE,T) Darwin, NT

Advisor to the Committee

Professor Jeremy Oats Chair, Victorian Consultative Council on Obstetric and Paediatric Mortality and Morbidity Medical Co-Director Northern Territory Integrated Maternity Services Professorial Fellow Department of Obstetrics and Gynaecology, University of Melbourne.

Committee secretariat

Mr Gokula Chandran, Research Officer (July 2013 to April 2014) Ms Hilary Berry, Senior Manager Policy and Investigations (April 2014 to June 2014) Ms Helena Gibbons, Consultant

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Glossary of terms

ABS Australian Bureau of Statistics

AGD Department of Attorney General and Justice, NT

AIFS Australian Institute of Family Studies

ANZCDR&PG Australia and New Zealand Child Death Review and Prevention Group

ASGC ABS Australian Standard Geographical Classification

BDM Northern Territory Office of the Registrar of Births, Deaths and Marriages

CDR Child Deaths Register

CDRPC Child Deaths Review and Prevention Committee

COD Cause of Death

Committee Child Deaths Review and Prevention Committee

Coroner Office of the NT Coroner

DCF Department of Children and Families, NT

DoH Department of Health, NT

ICD-10 AM International Statistical Classification of Diseases and Related Health

Problems, Tenth Revision – Australian Modified

LGA Northern Territory Local Government Areas

Menzies Menzies School of Health Research

NCIS National Coronial Information System

NSW New South Wales

NT Northern Territory

Qld Queensland

Register Child Deaths Register

SUDI Sudden Unexpected Death in Infancy

SIDS Sudden Infant Death Syndrome

the Act Care and Protection of Children Act

UCOD Underlying Cause of Death

WHO World Health Organisation

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Definitions

Aboriginal

The following definition is provided for the term Aboriginal in section 13 of the Care and Protection of Children Act:

Aboriginal means: (a) a descendant of the Aboriginal peoples of Australia; or (b) a descendant of the Indigenous inhabitants of the Torres Strait Islands.

Throughout this Report the term Aboriginal will be used for people of either Aboriginal or Torres Strait Islander descent except where specific reference is being made to publications that use other terminology, for example, the ABS which often uses the term Indigenous.

Cause of death (COD)

All those diseases, morbid conditions, or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced such injuries.1

Child

Part 1.4, section 13 of the Act defines child as (a) a person aged seventeen years and under; or (b) a person apparently less than 18 years of age if age cannot be proved.

Child death

Part 3.3, section 208 of the Act defines child death as (a) the death of a child who usually resided in the Territory (whether the death occurred in the Territory or not); or (b) a stillbirth as defined in the Births, Deaths and Marriages Registration Act that occurred in the Territory.

Greater Darwin

Greater Darwin incorporates the City of Darwin, the City of Palmerston and the Litchfield Shire.

Congenital malformations

Congenital malformations, including deformities and chromosomal abnormalities, are physical and mental conditions present at birth that are either hereditary or caused by environmental factors.

Infancy

The infancy period extends from birth to 12 months of age. An infant death is the death of a live born child under 1 year of age. 2

Neonatal

The neonatal period extends from birth to 28 days of age. A neonatal death is the death of a live born baby within 28 days of birth.3

1World Health Organisation (2008), ICD-10 International Statistical Classification of Diseases and Related Health

Problems, 10th Revision, Volume 2 Instruction Manual, 33-34.

2 Abeywardana, S. & Sullivan, E.A. (2008). Congenital anomalies in Australia 2002–2003. Birth anomalies series

no. 3 Cat. no. PER 41. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit.

3 Laws, P.J. & Hilder, L. (2008). Australia’s mothers and babies 2006. Perinatal statistics series no. 22.Cat. no.

PER 46. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit

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Perinatal

The perinatal period extends from 20 weeks gestation to 28 days following birth. A perinatal death is a fetal death (of at least 20 weeks gestation or at least 400 grams birthweight.4) or a neonatal death (of a live born within 28 days from birth).

Rest of the NT

Rest of the NT incorporates those areas outside the City of Darwin, the City of Palmerston and the Litchfield Shire.

Stillbirth (fetal death)

In accordance with section 4 of the Births Deaths and Marriages Registration Act, a stillbirth means the birth of a still-born child, which is defined as a child of at least 20 weeks gestation or with a body mass of at least 400 grams at birth that exhibits no sign of respiration or heartbeat, or other sign of life, after birth. 5

Sudden unexpected death in infancy (SUDI)

SUDI (also described as Sudden Unexpected Infant Death, SUID), is a term used for all unexpected infant deaths, whether the explanation is immediate, determinable after a thorough examination, or remains unknown. At one point all unexplained SUDI deaths were labelled as Sudden Infant Death Syndrome, SIDS.

Underlying cause of death (UCOD)

(a) the disease or injury which initiated the train of morbid events leading directly to death; or (b) the circumstances of the accident or violence, which produced the fatal injury (WHO).6

4 ibid

5 ibid

6 op cit

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Foreword

This is the sixth Annual Report of the Northern Territory (NT) Child Deaths Review and Prevention Committee. The report is based on information provided to the Committee on the 45 deaths of children whose usual place of residence is the NT and of 43 stillbirths that occurred during the calendar year 2013. The report also provides summary information on 241 child and infant deaths that occurred in the five-year period 2009-13.

The death of any child is a tragedy and the members of the Committee extend their sincere condolences to the family, friends and communities of the children and young people cited in this report. In highlighting the circumstances relating to these deaths and by conducting research based on identified patterns and trends, the Committee’s objective is to effect change that will prevent and reduce child deaths, accidents and diseases in the NT.

In addition to providing an analysis of the child and infant deaths that occurred during 2013 and the preceding four years, this report provides an overview of four literature reviews commissioned by the Committee to look at areas considered to be relevant to the prevention and reduction of child deaths in the NT. The Committee had previously commissioned research into intentional self-harm of children from 2006 to 2010; a follow up review for the period 2011-13 is included.

On behalf of the Committee I would like to thank the agencies and individuals across the Northern Territory that provided information for the Child Deaths Register as well as those who contributed to the development of this report. In particular, I would like to thank the Office of the Registrar of Births, Deaths and Marriages, the Department of Health, the NT Coroner, the Department of Children and Families and Ms Sue Walker of the National Centre for Health and Information Research and Training.

Dr Howard Bath Convenor NT Child Deaths Review and Prevention Committee 31 October 2014

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Executive summary

Background and overview of the Committee activities

The Committee is established pursuant to Part 3.3 of the Care and Protection of Children Act. The purpose of the child deaths review process undertaken by the Committee is to assist in the prevention and reduction of child deaths in the Northern Territory (NT). It achieves this through:

(a) maintaining a database on child deaths;

(b) conducting research about child deaths, diseases and accidents involving children; and

(c) contributing to the development of appropriate policy to deal with such deaths, diseases and accidents.

The Committee’s specific functions are set out in the Act (see Appendix 1).

Some of the activities that the Committee has undertaken this reporting year include:

(d) Working with government to formalise the Commissioner’s Convenor-ship and the secretariat arrangements;

(e) An audit of the Child Deaths Register (the Register);

(f) The completion of research undertaken into sleep-rated SUDI deaths in the NT, during the period 2006-12;

(g) An update on intentional self-harm deaths of children in the NT; and

(h) The commissioning of four literature reviews to help inform the Committee in its deliberations and research priorities.

Issues relating to child deaths data in the NT

Chapter 2 of the Report examines contextual factors and sources of data for the work of the Committee. This includes data obtained from national bodies such as the Australian Bureau of Statistics (ABS) and the National Coroners Information System (NICS), which provide data on child deaths and demographics.

The primary source of data on child deaths is obtained from the Office of the Registrar of Births, Deaths and Marriages (BDM) which also provides data on stillbirths in the NT. Other sources such as medical records from the Department of Health (DoH) and documents held by the Office of the NT Coroner provide additional detail relating to individual deaths.

Other issues include the following:

Although this is the Committee’s 2013-14 Annual Report, the focus is on child deaths for the calendar year 2013 with a further overview of calendar years 2009-13.

The need to maintain confidentiality of personal information consistent with the Committee’s statutory requirements;

Presentation of data is based on the actual date of death rather than the date of registration of the death which is used by some other agencies (e.g. ABS);

ICD-10-AM codes are used for classifying the cause of death in line with the practice of most other similar committees within Australia;

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For all child deaths that involved a review by the NT Coroner, the delivery of coronial findings follows a thorough coronial investigation to determine a cause of death before it is reported to BDM. This may take months, possibly years to complete these investigations, hence the delay in reporting these deaths;

The need to obtain additional data beyond that supplied by BDM;

The need to canvas other jurisdictions including other regions BDM registries, for information deaths on the deaths of NT children that occurred interstate.

Child deaths in the NT, 2009-13

Chapters 3 and 4 provide data on the deaths of children whose usual place of residence is the NT. The data for 2013 is current but it is important to view data aggregated over five years when determining trends or interpreting changes.

2013 snapshot

45 deaths of children whose usual place of residence is in the NT,

18 (40%) were male; 27 (60%) were female

28 (62%) were Aboriginal; 17 (37%) were non-Aboriginal

32 (71%) were from outside the Greater Darwin area.

23 (51%) of the 45 were infant deaths; 6 (13%) were 1 to 4 year olds, 1 (2%) was a 5 to 9 year old, 5 (11%) were 10 to 14 year olds and 10 (22%) were 15 to 17 year olds.

Of the 23 infant deaths, 7 (30.5%) were male and 16 (69.5%) were female; 14 (61%) were Aboriginal and 9 (39%) were non-Aboriginal.

Of the 23 infant deaths, 15 (65%) were neonatal (under 1 month old) deaths, of which 10 (67%) were Aboriginal and 5 (33%) were non-Aboriginal.

In addition, 43 stillbirths were registered as having occurred in the NT: 27 (63%) were male and 16 (37%) female; 27 (63%) were Aboriginal and 16 (37%), non-Aboriginal.

There were 58 perinatal (43 stillbirths + 15 neonatal) deaths registered in the NT; 37 (64%) were Aboriginal and 21 (36%) were non-Aboriginal.

2009-13 aggregate snapshot

241 deaths of children who were usually resident in the NT:

134 (56%) were male and 107 (44%) were female;

173 (72%) were Aboriginal and 68 (28%) were non-Aboriginal

170 (71%) were from outside the urban Greater Darwin area.

132 (55%) were infants; 32 (13%) were 1 to 4 years old, 17 (7%) were 5 to 9 years old, 26 (11%) were 10 to 14 years old and 34 (14%) were 15 to 17 years old.

Of the 132 infant deaths, 68 (51.5%) were male and 64 (48.5%) were female; 91 (69%) were Aboriginal and 40 (31%) were non-Aboriginal.

Of the 132 infant deaths, 83 were neonates, under one month of age of which 55 (66%) were Aboriginal and 28 (34%), non-Aboriginal.

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In addition, 173 stillbirths were registered in the NT: 102 (59%) were male and 70 (40%) female and 1 of unknown gender. 105 (61%) were Aboriginal and 68 (39%) were non-Aboriginal.

There were therefore 256 perinatal (173 stillbirths + 83 neonatal) deaths, registered in the NT, 160 (62.5%) were Aboriginal and 96 (37.5%) were non-Aboriginal.

The child death rate for the NT was 76.8 per 100,000 children, comprising rates of 125 and 38 per 100,000 for Aboriginal and non-Aboriginal children respectively. This gives a rate ratio of 3.3; the death rate of Aboriginal children in NT is over 3 times higher than that of non-Aboriginal children.

The infant death rate for the NT was 682.6 deaths per 100,000 infants comprising rates of 1,111 and 359 per 100,000 infants for Aboriginal and non-Aboriginals respectively, a rate ratio of 3.2

A breakdown of child deaths by usual residence shows that the number of child deaths in the Rest of the NT (70.5%) is far higher than those in Greater Darwin (29.5%) even though the population is similar in these two areas in the NT.

Of the 241 child deaths, 61 (25%) were families known to the Department of Children and Families (DCF).

Of the 222 child deaths for which detailed information is available, the most common causes (in 69 or 31% of deaths) occurred within the ‘external causes of morbidity and mortality’ category; these deaths are generally considered to be preventable. The second most common cause of death (66 or 30% of deaths) was in the ‘certain conditions originating in the perinatal period’ category.

Research

Chapter 5 provides an overview of the Committee’s research activities in 2013-14. A report based on the research undertaken into sleep-rated SUDI deaths in the NT, during the period 2006-12 is near completion and it is anticipated to be available on the Children’s Commissioner’s web site.

A study has been undertaken into intentional self-harm deaths of children in the NT for the period 2011-13. This was done in conjunction with the Office of the NT Coroner and is a follow up to a previous study undertaken in 2011 by the Menzies School Health Research (Menzies) for the years 2006-10.

The Committee commissioned Menzies to conduct four literature reviews into issues related to child deaths. These include:

bullying of young people in communities through the use of Facebook, Twitter, Instagram, and other forms of social media;

high number of hospital admissions of females under the age of 18, following incidents of violence (i.e. self-inflicted or due to assault);

review possible causes or contributing factors to the high number of perinatal deaths in the NT; and

parental supervision relating to child deaths, to include the monitoring of children using quad bikes; children roaming the streets unsupervised; safety around storm water drains; and the monitoring of safety relating to electrical powers points.

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CHAPTER 1

Introduction

This is the Child Deaths Review and Prevention Committee’s (CDRPC or Committee) sixth annual report. It provides information related to the deaths of 45 children under the age of 18 years whose usual place of residence is in the Northern Territory (NT) and 43 stillbirths registered in 2013. The report also includes information on child deaths and stillbirths from 2009 to 2013 for comparative and historical purposes.

Background

The Care and Protection of Children Act (the Act) was passed by the NT Legislative Assembly in November 2007 and contains provisions relating to the prevention of child deaths. The objective of this part of the Act is to assist in the prevention and reduction of child deaths (under the age of 18 years) in the NT, including stillbirths.

One of the most tragic events a family and community can experience is the death of a child, an event which is made even more tragic if it could have been prevented. A recent response to these tragedies, both nationally and internationally, has been the establishment of committees tasked with reviewing the deaths of children and young people within their jurisdictions. The scope of these committees vary between the jurisdictions, however there is a common focus which is to identify patterns and trends associated with child deaths in order to influence legislation/policies that may reduce and prevent child deaths in the future.

While there is capacity to review individual child deaths on a case-by-case basis, the Committee’s focus is to analyse the trends and patterns on an aggregate basis, by cause or type of death. This allows the Committee to investigate in greater detail the factors relating to deaths and death rates in order to meet its legislative functions to make recommendations aimed at reducing and preventing the number of child deaths, accidents and diseases in the NT.

Legislation

The Child Deaths Review and Prevention Committee is an independent statutory body established under with provisions contained in Part 3.3 of the Care and Protection of Children Act. (Refer to Appendix 1).

Roles and functions of the Committee

The CDRPC is established under provisions contained in the Care and Protection of Children Act (the Act), Part 3.3 – Prevention of child deaths. The primary objective of this part of the Act is to assist in the prevention and reduction of child deaths through:

(a) maintaining a database on child deaths; and

(b) conducting research about child deaths; and diseases and accidents involving children; and

(c) the development of appropriate policy to deal with such deaths, diseases and accidents.

The Committee’s functions are:

to establish and maintain the Child Deaths Register;

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to conduct or sponsor research into child deaths, diseases and accidents involving children and other related matters (such as childhood morbidity and mortality), whether alone or with others;

to make recommendations on the research into child deaths, diseases and accidents;

to monitor the implementation of the recommendations;

to raise public awareness in relation to:

(i) the death rates of children;

(ii) the causes and nature of child deaths and diseases and accidents involving children;

(iii) the prevention or reduction of child deaths, diseases and accidents;

to contribute to any national database on child deaths in Australia;

to enter into an arrangement for sharing of information with anyone in Australia who has functions similar to those of this Committee;

to perform any other functions as directed by the Minister in relation to the object of this legislative provision.

At the end of each financial year the Committee is required to prepare a report about the operation of the Committee during that financial year. Should the Committee conduct or sponsor research about issues identified as being relevant to child deaths in the NT, the resulting report must also be presented to the Minister. The Minister is required to table the Committee’s Annual Report and research report/s in the Legislative Assembly.

The Committee is required by legislation to conduct a least three meetings a year. For the financial year, 2013-14 the Committee held seven meetings and has therefore fulfilled this statutory requirement.

Structure and membership of the Committee

The legislation requires that there is a CDRPC and that it must consist of at least 10, but no more than 16 members. Each member of the Committee is required to have qualifications and experience relating to the functions of the Committee. The legislation also requires that the Deputy Coroner and at least two Aboriginal persons be members of the Committee, and that there is a convenor and deputy convenor.

Members are appointed by the Minister (Minister for Children and Families) for a period up to two years, with the option of a further two year appointment. The legislation also allows for the appointment of advisors to the Committee.

As of 30 June 2014, the CDRPC consisted of 14 senior representatives from government and independent agencies with expertise in the areas of health care (including hospital and community based clinical care), remote health, child development, child protection, research, education, legal, policing and public health.

The Committee’s convenor is Dr Howard Bath, a role he has held since the inception of the CDRPC in February 2009. Dr Bath is also the NT Children’s Commissioner and the secretariat functions of the Committee are undertaken by employees of the Office of the Children’s Commissioner. The NT Deputy Coroner, Ms Kathryn Ganley, is the appointed Deputy Convenor of the Committee.

Professor Jeremy Oats, Chair of the Victorian Council on Obstetric and Paediatric Mortality and Morbidity, Medical Co-Director of the NT Integrated Maternity Services, Professorial

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Fellow Department of Obstetrics and Gynaecology, University of Melbourne, is appointed to be an advisor to the Committee.

Provision of information to the Committee

To assist the CDRPC to fulfil its statutory functions, section 211 of the Act, outlines a number of ‘persons’ who must provide information relevant to the Committee’s functions. These include:

the Commissioner of Police

the Registrar of Births, Deaths and Marriages

a Coroner

a health practitioner; including

a person in charge of health services in which children are patients.

The Child Deaths Register

Under the Care and Protection of Children Act, there is a statutory obligation for the CDRPC to establish and maintain a Child Deaths Register (the Register). The Register contains information relating to the deaths of children and young people under the age of 18 years whose usual place of residence is the NT. Section 208 of the Act, defines a child death as:

a) the death of a child who usually resided in the Territory (whether the death occurred in the Territory or not); or

b) a stillbirth as defined in the Births, Deaths and Marriages Registration Act that occurred in the Territory.

The Register contains information related to date of birth, date of death, date of death registration, age, gender, Aboriginal and Torres Strait Islander status, place of birth, place of death, usual place of residence and family details. Information is also gathered in relation to the underlying causes of deaths and external factors which may have contributed to the death.

Information in the Register is predominantly sourced from data held by a number of NT government agencies, including the Department of Attorney-General and Justice (AGD), the Registry of Births Deaths and Marriages (BDM), the Office of the NT Coroner, the Department of Health (DoH) and the Department of Children and Families (DCF). Information is also provided by government funded health clinics and private medical centres. More recently, the Committee has been provided access to the National Coroner’s Information System (NCIS).

Information relating to the deaths interstate of children whose usual place of residence is the NT, is sourced either from child death registers of other jurisdictions or the respective state or territory BDMs.

As with previous years, a key component of the Committee’s work is ensuring the Register contains information to suit the unique requirements of the NT, whilst being comparable to the registers of other Australian jurisdictions.

Activities of the Committee

Audit of Child Death Register

In June 2014, an internal audit was undertaken to ensure the integrity and reliability of the information held in the Register. The audit covered the accuracy of the data covering the period 2009 to 2013, which is the reporting period for this year’s Annual Report.

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Research

A key function of the CDRPC is to conduct or sponsor research aimed at preventing and reducing child deaths in the NT.

Research into SUDI deaths 2006-12

The Committee has completed research into 38 sleep-related infant deaths that occurred during the period 2006-12. These deaths were all sudden unexpected deaths in infancy (SUDI) including those classified as Sudden Infant Death Syndrome (SIDS).

The decision to commission research into this particular area of child deaths was made after it was identified that the NT’s rates for SUDI was nearly three times greater than the reported Australian rate.

Based on these findings, the Committee decided to conduct further study of the trends and associated risk factors for these deaths to cover all sleep-related infant deaths in the NT. The study focused on a review of recently published and unpublished literature on this topic in the NT context.

A draft of the report entitled ‘A Report of Sleep-Related Infant Deaths in the NT; 2006-2012’ has been circulated to members for comment and is in the final stages of review prior to being forwarded to the Minister for tabling in the NT Legislative Assembly.

Literature reviews

The Committee also commissioned the Menzies to conduct literature reviews into issues related to child deaths in the NT. These include:

The bullying of young people in communities through the use of Facebook, Twitter, Instagram, and other forms of social media;

The high number of hospital admissions of females under the age of 18, following incidents of violence (i.e. self-inflicted or due to assault);

A review of possible causes or contributing factors to the high number of perinatal deaths in the NT; and

The issue of parental supervision relating to child deaths, to include the monitoring of children using quad bikes; children roaming the streets unsupervised; safety around storm water drains; and the monitoring of safety relating to electrical power points.

These literature reviews will help inform the Committee’s continuing research program.

Update on the 2011 research into suicide deaths of children and young people

In 2011, the Committee commissioned Menzies to conduct research into the suicide deaths of children and young people (under the age of 18 years) between the years, 2006-A10. The decision to sponsor this research was based on the Committee’s findings that the incidences of child and young suicide appeared to be higher in the NT than in other jurisdictions.

The completed report ‘Suicide of Children and Youth in the NT, 2006-2010’ highlighted the fact that over four years there has been a sustained increase in NT suicide rates within the target population. It indicated that although there had been a slight decrease in the very high number of young people (over 18 years of age) who had suicided, there had been an increase in suicide deaths of young people under 18. It was further noted that there was a relatively high proportion of female deaths compared with rates elsewhere in Australia.

A report by the Committee, based on the Menzies’ study was tabled in the NT Legislative Assembly in early 2012. This included 15 recommendations aimed at preventing and

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reducing the number of suicides by young Territorians. To date the Committee has not had advice from Government as to whether it has accepted the recommendations.

Chapter 5 of this report provides an update on an additional 17 intentional self-harm deaths of children for the period 2011-13.

National representation and engagement

The CDRPC has representation on the Australian and New Zealand Child Deaths Review and Prevention Group (ANZCDR&PG), which comprises of representatives from all the Australian jurisdictions and New Zealand.

The aim of the ANZDR&PG is to identify, address and potentially decrease the number of infant and children deaths by the sharing of information relating to the individual jurisdictions and working collaboratively towards improving national and international reporting.

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CHAPTER 2

Issues relating to child death data in the Northern Territory

Sources of data on child deaths

Australian Bureau of Statistics

The Australian Bureau of Statistics (ABS) publishes a series of reports and tables on deaths that occur in all Australian jurisdictions. These reports, based on data forwarded by the various jurisdictions, provide information on distribution by age and gender, death rates, causes of death and Aboriginal status. The accompanying tables provide data for analysis of trends over time.

A particular problem experienced by the Committee is the considerable time lag between the date of death as recorded by the NT BDM Registry and the publication of the ABS reports. There are a number of other limitations with the ABS data, for example: only the medical causes of death are recorded and not the related or underlying causes such as the social factors that may have contributed to the deaths. Another difficulty is that the ABS child death tables do not provide data for each individual year of age so deaths of 17 year olds, for example, are included in the 15-19 age grouping. As a result, it is not possible for child death review committees to base their reviews and recommendations solely on ABS reports.

Registry of Births, Deaths and Marriages

The main source of information for child deaths is the Register is the Department of Attorney-General and Justice’s (AGD) Registry of Births, Deaths and Marriages. This information is provided electronically on a monthly basis and includes:

the child’s name

the child’s date of birth

the child’s usual residence

the child’s age

the child’s gender

the child’s occupation, if any

the child’s Aboriginal or Torres Strait Islander status

the date and place of death

the cause of death (where available)

The Registry of Births, Deaths and Marriages also provides information relating to stillbirths in the NT and includes:

the infant’s name (where provided)

the gestation weight

gestation age (in weeks)

date of death

place of death.

Office of the NT Coroner

The Office of the NT Coroner provides information related to those deaths of children deemed to be reportable in under provisions contained in the Coroner’s Act.

A reportable death is defined as a death that;

appears to have been unexpected, unnatural or violent;

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appears to have resulted, directly or indirectly from an accident or injury;

occurred during an anaesthetic or as a result of an anaesthetic and is not due to natural causes,

occurred when a person was held in, or immediately before death, was held in care or custody,

was caused or contributed to by injuries sustained while the person was held in custody,

is of a person whose identity is unknown,

and in certain other circumstances.

The death of a child that is considered to have occurred whilst being in care or custody includes those circumstances:

where the child or young person is deemed to be ‘in care’ in accordance with provisions contained in the Care and Protection of Children Act; or

where the child or young person is an involuntary patient under the Mental Health and Related Services Act, whether in hospital or temporarily removed from hospital; or

if the young person’s death occurs in a detention centre approved under the Youth Justice Act.

The National Coroner’s Information System

In June 2014, the Committee was granted restricted access to the National Coroner’s Information System (NCIS) to access information related to reportable deaths in the NT. Coroners from all jurisdictions contribute to this database and authorised researchers, such as those associated with child death review committees, can access this information. The NCIS provides valuable information on causes of death and clusters at a state or national level that might warrant the attention of researchers or policy-makers. NCIS is not usually used as a primary data source by most other child death review committees as there are restrictions on the continuing use of data for research.

Other sources of data

The Department of Health (DoH) provides the Committee with perinatal data relating to mothers’ antenatal care, maternal health, pregnancy, labour and childbirth and perinatal health. This information is held in the Midwife’s Collection.

Confidentiality of information

The Care and Protection of Children Act contains provisions that help ensure the confidentiality of information obtained by the Committee in the exercising of its statutory responsibilities. It is an offence under the Act for a person to disclose, or use information obtained as part of the performance of their functions.

The Act allows for the disclosure of information for the purposes of research; as part of an Inquiry or investigation conducted by Police or a Coroner; to a court or tribunal, or where otherwise required or authorised by law.

Coding cause of death

The Committee uses the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 which was developed by the World Health Organisation, WHO) to code the underlying and multiple causes of death. The ICD-10 is

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designed to promote international compatibility in the collection, processing, classification and presentation of morbidity and mortality statistics. ICD-10-AM (Australian Modified) has been modified to ensure that the classification is current and appropriate for Australian clinical practice whilst ensuring that international compatibility is maintained.

Calendar year reporting

The Committee has elected to report on child deaths based on the calendar year as opposed to the financial year. The majority of other Australian jurisdictions use the same reporting period.

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CHAPTER 3

Child deaths in the Northern Territory

Chapter Three provides statistical data related to child deaths in the calendar year 2013 and for the period 2009-13. The data includes demographic details relating to age, gender, Aboriginal status, and underlying cause of death and whether the child and/or a sibling is known to the child protection system. Updated data is used in the present report so there may be some variations in the data reported for previous years.

Child deaths in 2013

As shown in figure 1 there were 45 child deaths registered in 2013. The highest number of deaths 23 (51%) occurred during infancy, with 6 (14%) deaths in the 1 to 4 year age group, 1 (2%) in the 5 to 9 years age group, 5 (11%) 10 to 15 years and 10 (22%) in the 15 to 17 years age group.

Figure 1: Number of child deaths by age group, NT, 2013

Age group No.

< 1 year 23

1 - 4 years 6

5 - 9 years 1

10 - 14 years 5

15 - 17 years 10

Total 45

Source: NT Child Deaths Register

Table 1 provides a breakdown of the total number of deaths by age group and gender. Females accounted for 27 (60%) of the child deaths with 18 (40%) being males. Significantly more female than male deaths occurred in infancy (16 vs 7). This is an unusual result given that in most years, there are more male than female deaths and the five-year total (Tables 1 and 2) show that the clear majority are males. Twenty-eight (63%) of the child deaths were of Aboriginal children and 17 (37%) were non-Aboriginal children (see Table 3).

< 1 year 51%

1 - 4 years 14%

5 - 9 years 2%

10 - 14 years 11%

15 - 17 years 22%

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Table 1: Number of child deaths by age group and gender, NT, 2013

Age Group Female Male Total

< 1 year 16 7 23

1 - 4 years 2 4 6

5 - 9 years 1 1

10 - 14 years 4 1 5

15 - 17 years 5 5 10

Total 27 18 45 Source: NT Child Deaths Register

Child deaths, 2009-13

Between 1 January 2009 and 31 December 2013, 241 deaths of children normally resident in the NT, were registered.

Table 2: Child deaths by year, gender and age group, NT, 2009-13

Year and Gender < 1 year 1 - 4

years 5 - 9

years 10 - 14 years

15 - 17 years

Total (%)

2009 Female 12 1 1 2 1 17 (36.2)

Male 15 6 3 4 2 30 (63.8)

Subtotal 27 7 4 6 3 47 (100)

2010 Female 13 1 1 3 1 19 (45.2)

Male 10 4 3 2 4 23 (54.8)

Subtotal 23 5 4 5 5 42 (100)

2011 Female 11 5 2 2 3 23 (37.1)

Male 26 3 2 3 5 39 (62.9)

Subtotal 37 8 4 5 8 62 (100)

2012 Female 12 2 3 2 2 21 (46.7)

Male 10 4 1 3 6 24 (53.3)

Subtotal 22 6 4 5 8 45 (100)

2013 Female 16 2 0 4 5 27 (60.0)

Male 7 4 1 1 5 18 (40.0)

Subtotal 23 6 1 5 10 45 (100)

Total Female 64 11 7 13 12 107 (44.4)

Male 68 21 10 13 22 134 (55.6)

Total 132 32 17 26 34 241 (100) Source: NT Child Deaths Register Totals may differ from last year’s report due to late registrations and interstate deaths

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The majority of child deaths occurred during infancy (132 or 54.8%), a pattern that is consistent with other states and territories. Across the years the 5-9 years age group had the fewest deaths (7.1%). The 15-17 years age group is the second largest group (although it only includes three years) and there are increasing numbers in this group over the 5 year period, from 3 deaths in 2009 to 10 in 2013.

Whilst males made up 51.9% of all children in the NT population (ABS 2012), they accounted for 55.2% of all child deaths over these years.

Child deaths by year, Aboriginal status and age group, NT, 2009-13

Of the 241 child deaths from 2009 to 2013, Table 3 shows that the number of Aboriginal deaths has greatly exceeded those of non-Aboriginal children for each of the past five years. Aboriginal children make up 43.6% of the total NT child population yet they accounted for over 72% (173) of all child deaths during the five year period.

Table 3: Child deaths by year, Aboriginal status and age group, NT, 2009-13

Year and Aboriginal status

< 1 year 1 - 4

years 5 - 9

years 10 - 14 years

15 - 17 years

Total (%)

2009 Aboriginal 19 6 3 2 2 32

Non-Aboriginal 8 1 1 4 1 15

Subtotal 27 7 4 6 3 47

2010 Aboriginal 14 3 3 4 3 27

Non-Aboriginal 9 2 1 1 2 15

Subtotal 23 5 4 5 5 42

2011 Aboriginal 28 6 4 4 8 50

Non-Aboriginal 9 2 1 12

Subtotal 37 8 4 5 8 62

2012 Aboriginal 16 5 3 5 7 36

Non-Aboriginal 6 1 1 1 9

Subtotal 22 6 4 5 8 45

2013 Aboriginal 14 4 1 3 6 28

Non-Aboriginal 9 2 2 4 17

Subtotal 23 6 1 5 10 45

Total Aboriginal 91 24 14 18 26 173

Non-Aboriginal 41 8 3 8 8 68

Total 132 32 17 26 34 241 Source: NT Child Deaths Register Totals may differ from last year’s report due to late registrations and interstate deaths

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Child deaths by usual residence, age group, gender and Aboriginal status, NT, 2009-13

Usual residence refers to the child’s usual place of residence as recorded in the BDM register and as reported by the parents or next of kin. For the purposes of this report, usual residence has been classified as either Greater Darwin or the Rest of the NT.

Table 4: Child deaths by usual residence, age group, gender and Aboriginal status,

NT, 2009-13

Usual residence

Greater Darwin Rest of the NT Total

Age group No. (%) No. (%) No. (%)

< 1 year 46 (34.8) 86 ( 65.2) 132 (100)

1 - 4 years 11 (34.4) 21 (65.6) 32 (100)

5 - 9 years 5 (29.4) 12 (70.6) 17 (100)

10 - 14 years 1 (3.8) 25 (96.2) 26 (100)

15 - 17 years 8 (23.5) 26 (76.5) 34 (100)

Total 71 (29.5) 170 (70.5) 241 (100)

Gender

Female 29 (27.1) 78 (72.9) 107 (100)

Male 42 (31.3) 92 (68.7) 134 (100)

Total 71 (29.5) 170 (70.5) 241 (100)

Aboriginal status

Aboriginal 27 (15.6) 146 (84.4) 173 (100)

Non-Aboriginal 44 (64.7) 24 (35.3) 68 (100)

Total 71 (29.5) 170 (70.5) 241 (100) Source: NT Child Deaths Register

The majority of child deaths for the period 2009 to 2013 occurred outside Greater Darwin, even though the NT child population is evenly distributed between Greater Darwin and the rest of NT (figure 2). The largest differential is for the 10-14 year age group –25 (96%) out of 26 deaths in this age group occurred outside of the Greater Darwin region. In the oldest age group, 15-17 years, 26 (76.5%) of child deaths also occurred outside of the Greater Darwin region.

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Figure 2: Proportion of child deaths and population by usual residence, NT, 2009-13

Source: NT Child Deaths Register1 NT population aged less than 18 years old (ABS 3235.0, 2008 and 2013)

Infant deaths, 2009-13

As shown in Table 5, there were 132 infant deaths between 2009 and 2013 in the NT, with a slight majority (51.5%) being males. A significant majority (68.9%) were Aboriginal children.

Table 5: Infant deaths by gender and Aboriginal status, NT, 2009-13

Gender Aboriginal status

Female Male Total Percentage

Aboriginal 37 54 91 68.9

Non-Aboriginal 27 14 41 31.1

Total 64 68 132 100

Percentage 48.5 51.5 100 Source: NT Child Deaths Register

Stillbirths, 2009-13

The definition of child death provided in Section 208 of the Care and Protection of Children Act includes stillbirths as defined in the Births, Deaths and Marriages Registration Act. This Act defines a stillborn child as ‘a child of at least 20 weeks gestation or with a body mass of at least 400 grams at birth that exhibits no sign of respiration or heartbeat, or other sign of life, after birth’. For the purposes of the CDRPC it was decided to report and analyse stillbirths separately from child deaths, as is the case in other Australian jurisdictions where stillbirths are registered.

29.5%

50.8%

70.5%

49.2%

0.0%

20.0%

40.0%

60.0%

80.0%

Child Deaths Child Population

Greater Darwin

Rest of the NT

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Table 6: Stillbirths by Aboriginal status and year, NT, 2009-13

Year 2009 2010 2011 2012 2013 Total Percentage

Aborginal status

Aboriginal 28 22 15 13 27 105 61

Non-Aboriginal 15 11 13 13 16 68 39

Total 43 33 28 26 43 173 100 Source: NT Child Deaths Register The individual totals may differ from last year’s report due to late registration or interstate deaths

There were 173 stillbirths reported between 2009 and 2013. Of these stillbirths 105 (61%) were Aboriginal and 68 (39%) were non-Aboriginal. Males accounted for 102 (59%), females 70 (40%) and 1 was unknown.

From Table 6 it can be seen that with the exception of 2012, the majority of recorded stillbirths per year over the period were Aboriginal.

Neonatal deaths, 2009-13

A neonatal death is defined as the death of a live-born baby within 28 days of its birth.

Table 7: Neonatal deaths by year and Aboriginal status, NT, 2009-13

Year 2009 2010 2011 2012 2013 Total Percentage

Aboriginal status

Aboriginal 12 9 17 7 10 55 66

Non-Aboriginal 5 8 7 3 5 28 34

Total 17 17 24 10 15 83 100 Source: NT Child Deaths Register

Between 2009 and 2013 there were 83 neonatal deaths in the NT. From Table 7 it can be seen that 66 per cent of these neonatal deaths were Aboriginal. Of which 38 were female and 45 were male. As with infant deaths, a greater proportion of neonatal deaths were male (54%).

Perinatal deaths, 2009-13

In Australia, the perinatal period commences at the 20th completed week of gestation and ends 28 completed days after birth. Perinatal deaths are a combination of stillbirths and neonatal deaths (as defined in the NT Births, Deaths and Marriages Registration Act).

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Table 8: Perinatal deaths by type, Aboriginal status and year, NT, 2009-13

Year 2009 2010 2011 2012 2013 Total Percentage Aboriginal

Status (%)

Type of Death

Aboriginal

Neonatal 12 9 17 7 10 55 34

Stillbirth 28 22 15 13 27 105 66

Subtotal 40 31 32 20 37 160 (63) 100

Non-Aboriginal

Neonatal 5 8 7 3 5 28 29

Stillbirth 15 11 13 13 16 68 71

Subtotal 20 19 20 16 21 96

(38) 100

Total 60 50 52 36 58 256

(100) Source: NT Child Deaths Register Individual totals may differ from last year’s report due to late registration or interstate deaths

There is an elevated risk of death in the perinatal period and the Committee specifically monitors this period. Table 8 shows stillbirths and neonatal numbers amongst the Aboriginal and non-Aboriginal populations over the past five years. The data show more stillbirths 173 (67.5%), with 83 (32.5%) neonatal deaths over the five year period.

Stillbirths decreased each year from 2009 (48) to 2012 (25). However, in 2013 the number of stillbirths increased markedly to 43. Neonatal deaths have ranged from 10 in 2012 to 24 in 2011.

Post-neonatal deaths, 2009-13

The post-neonatal period is the period from 28 days up to 1 year of age.

Table 9: Post neonatal infancy by Aboriginal status and year, NT, 2009-13

Year 2009 2010 2011 2012 2013 Total

Post-neonatal

Aboriginal 7 5 11 9 4 36

Non-Aboriginal 3 1 2 3 4 13

Total 10 6 13 12 8 49 Source: NT Child Deaths Register

Table 9 shows post-neonatal infant deaths over the past 5 years by Aboriginal status. It can be seen that there have been many more post-neonatal infant deaths in the Aboriginal population.

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Child death rates

Child death rates are a useful measure that adjusts the number of deaths for differences in the population size. The rates of child deaths is reported here as number of deaths per 100,000 population of children, or as the number of deaths in infancy per 1000 live births, both of which are standard units of measurement. Rates within age groups are reported similarly, as age-group specific rates.

Table 10: Child death rates by year, NT, 2009-13

Year Number of deaths Rate#

2009 47 75.4

2010 42 67.0

2011 62 99.5

2012 45 71.5

2013 45 70.8

Total 241 76.8 Source: NT Child Deaths Register and ABS 3101, Dec 2013 # per 100,000 children

Figure 3: Child death rates by year, NT, 2009-13

Source: NT Child Deaths Register, and ABS 3101, Dec 2013 # per 100,000 children

In this report, population numbers for the denominator are based on ABS Estimated Residential Population data for single years – for children aged 0-17 years in the NT (ABS Cat. 3101.0, 2013). Given the relatively small number of deaths each year in the NT, aggregating data across five years provides a more reliable indicator of the underlying rates.

Based on the total number of NT child deaths between 2009 and 2013 (241), the combined rate over this five year period was 76.2 deaths per 100,000 children. Table 10 and Figure 3 show the rates for each of the past five years.

75.4 67.0

99.5

71.5 70.8

2009 2010 2011 2012 2013

Child Death Rate#

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Table 11: Child death rates by age-group, NT, 2009-13

Age group Number of deaths

Rate#

< 1 year 132 682.6

1 - 4 years 32 43.1

5 - 9 years 17 19.3

10 - 14 years 26 31.2

15 - 17 years 34 69.9

Total 241 76.8 Source: NT Child Deaths Register and ABS Cat 3101, Dec 2013 # per 100,000 children

The age-group specific death rates for this five year period are shown in table 11. The infant death rate of 682.6 deaths per 100,000 infants is seen to be the major portion of the overall child death rate; this rate is close to ten times that of the 15 to 17 year-olds (69.9 per 100,000).

Table 12: Child death rates by age group and gender, NT, 2009-13

Number of Deaths Rate#

Age Group Male Female Male Female

< 1 year 68 64 682.5 682.7

1 - 4 years 21 11 54.7 30.6

5 - 9 years 10 7 38.7 30.7 10 - 14

years 13 13 28.8 30.3 15 - 17

years 22 12 50.6 30.0

Total 134 107 82.3 70.9 Source: NT Child Deaths Register and ABS Cat 3101, Dec 2013 # per 100,000 children

Some totals may differ from last year’s report due to late registration and interstate deaths.

Of the 241 deaths, 134 (55.6%) were male and 107 (44.4%) were female. The respective rates were 82.3 for males and 70.9 for females for an overall rate of 76.8 per 100,000 children. Whereas the gender rates for infants are similar, it can be seen in Table 12 that males in the 1 – 4 and 15 - 17 age groups have significantly higher death rates than females.

From Table 12 it can be seen that the infant death rate across the 5 year period stands at 682.5 (6.8 per 1,000) for males and 682.7 (6.8 per 1,000) for females per 100,000 children.

Deaths of children with a family involvement in child protection services 2009-13

Children involved with the child protection system are considered to be a particularly vulnerable subgroup of the population. Given that the risk is often associated with families, it is prudent that child death committees consider the ‘child protection’ history of children who have died as well as that of their siblings, as an indicator of vulnerability.

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Of the 241 child deaths registered in the NT between 1 January 2009 up to 31 December 2013, 61 (25%) children were ‘known’ and 180 (75%) were ‘not known’ to the Department of Children and Families (DCF) within the three years prior to their death (figure 4).

A child is considered to be ‘known’ to the child protection system if an ‘action’ has been taken under Chapter 2 of the Care and Protection of Children Act to safeguard the wellbeing of the child. This ‘action’ by DCF can involve a single intervention such as a child abuse notification, or comprise a number of different actions including the assessing of child abuse notifications, child protection investigations, the undertaking of protective assessments, the provision of family support services, the taking out of statutory child protection orders, or the placement of a child into care.

The death of a child who is in the care of the Chief Executive Officer of DCF is required by law to be referred to the Office of the NT Coroner for him/her to make a finding on the child’s death. In the present reporting period there have been 7 deaths of children who were on statutory orders with none of these deaths being related to child protection issues.

Figure 4: Number of child deaths by ‘known/ not known to DCF’ status, NT, 2009-13

Source: NT Child Deaths Register

Many of the children known to child protection services originate from families characterised by dysfunction, including domestic and family violence, alcohol, drug and volatile substance abuse, mental illness, and involvement with the criminal justice system.

Of the 61 child deaths known to DCF, 40 had siblings who at some time also had involvement in the child protection system.

180 (75%)

61 (25%)

Children known to DCF

Children not known to DCF

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Table 13: Characteristics of child death by known to DCF status, NT, 2009-13

Child Characteristics

Known to DCF Number

Not Known to DCF

Number

Gender

Female 23 84

Male 38 96

Total 61 180

Aboriginal Status

Aboriginal 51 122

Non-Aboriginal 10 58

Total 61 180

Location

Greater Darwin 18 53

Rest of NT 43 127

Total 61 180

Age Group

< 1 year 18 114

1 - 4 years 10 22

5 - 9 years 8 9

10 - 14 years 12 14

15 - 17 years 13 21

Total 61 180 Source: NT Child Deaths Register

As shown in Table 13, Of the 61 children known to DCF, 18 (29.5%) were in the <1 year age group; 16.3 per cent in the 1 to 4 age range; 13.1 per cent in 5 to 9 age range; 19.7 per cent in the 10 to 14 age range; and 21.3 per cent in the 15 to 17 year age range.

Of the deaths of children involved in the child protection system, 51 (84%) per cent were Aboriginal and 10 (16.4%) were non-Aboriginal.

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CHAPTER 4

Underlying causes of child deaths in the Northern Territory, 2009-13

Child deaths have been coded using the World Health Organisation’s (WHO) International Classification of Diseases (Version 10: ICD-10). Using this coding system, the underlying cause of death (UCOD) is considered the primary classification. The UCOD is defined as ‘(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury’ (WHO), 2008).

The WHO distinguishes between the UCOD and the cause of death (COD). The COD is defined as ‘all those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries.’ (WHO, 2008).

This section provides information about the UCOD for 222 of the 241 child deaths in this five year reporting period. At the time of this report, seven deaths still require cause of death coding and 12 are awaiting the outcome of coronial investigations. Two of these deaths are from 2012 and the remaining 10 are from 2013.

Table 14: Underlying cause of child death by ICD-10AM chapter, NT, 2009-13

ICD-10-AM chapter No.

Code prefix

ICD-10-AM chapter descriptions Number Percentage

1 A and B Certain infectious and parasitic diseases 4 1.7%

2 C and D Neoplasms 5 2.1%

4 E

Endocrine, nutritional and metabolic diseases 2 0.8%

6 G Diseases of the nervous system 12 5.0%

8 H Diseases of the ear and mastoid process 1 0.4%

9 I Diseases of the circulatory system 2 0.8%

10 J Diseases of the respiratory system 6 2.5%

11 K Diseases of the digestive system 1 0.4%

16 P

Certain conditions originating in the perinatal period 66 27.4%

17 Q

Congenital malformations, deformations and chromosomal abnormalities 19 7.9%

18 R

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 35 14.5%

20 U-Y External causes of morbidity and mortality 69 28.6%

Not yet coded

Awaiting coronial findings and/or cause of death* 19 7.9%

Total 241 100.0% Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

Table 14 broadly outlines the UCOD for children in the NT by ICD-10-AM Chapter. The majority of deaths occurred in the ‘external causes or morbidity and mortality’ chapter category, followed closely by ‘conditions originating in the perinatal period’.

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Of the 69 external causes of death, 20 (29%) were intentional self-harms, 16 (23%) related to accidents involving motor vehicles, 7 (1%) were drowning’s and 4 (.05%) involved attacks by crocodiles. A more detailed analysis of the 20 intentional self-harm deaths is contained in Chapter 5 of the report.

Underlying cause of death by year, NT, 2009-13

Tables 15 to 18 provide a comparative breakdown of the UCOD by reporting years, gender and Aboriginal status, usual residence and age groups.

Table 15: Underlying cause of death by ICD-10 chapter and year, NT, 2009-13

ICD-10-AM chapter descriptions 2009 2010 2011 2012 2013 Total

Certain infectious and parasitic diseases 2 (4.3)

2 (3.2)

4 (1.7)

Neoplasms 1 (2.1)

1 (2.4)

2 (3.2)

1 (2.2)

5 (2.1)

Endocrine, nutritional and metabolic diseases

1 (2.1)

1 (2.2)

2 (0.8)

Diseases of the nervous system 3 (6.4)

2 (4.8)

5 (8.1)

1 (2.2)

1 (2.2)

12 (5.0)

Diseases of the ear and mastoid process

1 (2.2)

2 (0.4)

Diseases of the circulatory system

1 (2.4)

1 (1.6)

2 (0.8)

Diseases of the respiratory system

1 (2.4)

2 (3.2)

2 (4.4)

1 (2.2)

6 (2.5)

Diseases of the digestive system 1 (2.1)

1 (0.4)

Certain conditions originating in the perinatal period

14 (29.8)

16 (38.1)

19 (30.6)

4 (8.9)

13 (28.9)

66 (27.4)

Congenital malformations, deformations and chromosomal abnormalities

9 (19.1)

2 (4.8)

4 (6.5)

1 (2.2)

3 (6.7)

19 (7.9)

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

7 (14.9)

6 (14.3)

11 (17.7)

10 (22.2)

1 (2.2)

35 (14.5)

External causes of morbidity and mortality 9 (19.1)

13 (31.0)

15 (24.2)

17 (37.8)

15 (33.3)

69 (28.6)

Awaiting coronial findings and/or cause of death*

1 (1.6)

8 (17.8)

10 (22.2

19 (7.9)

Total 47 (100)

42 (100)

62 (100)

45 (100)

45 (100)

241 (100)

Source: NT Child Deaths Register proportions may differ from last year’s report due to updated numbers, late registrations etc. *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

The two major underlying causes of death over the 5 years are ‘external causes of morbidity and mortality’ and ‘certain conditions originating in the perinatal period’. Both these chapters are consistently higher for all years except in 2012 where UCOD ‘symptoms, signs and

P a g e 39

abnormal clinical and laboratory findings, not elsewhere classified’ were higher than the perinatal period by 6 deaths.

Of the 69 external causes, notable causes of deaths were:

20 intentional self-harm (3 in 2010, 3 in 2011, 6 in 2012, 8 in 2013).

16 accidents involving motor vehicles (1 in 2009, 5 in 2010, 7 in 2011, 3 in 2012, 0 in 2013 n=0). The 2013 figure in particular may change due to the number of outstanding cases before the Coroner.

7 drowning deaths (1 in 2009, 0 in 2010, 2 in 2011, 2 in 2012, 2 in 2013).

4 crocodile attacks (1 in 2009, 1 in 2011, 2 in 2012).

It is interesting to note that over the same reporting period the number of perinatal deaths were relatively consistent mid to high teens - with the exception of 2012 where there were 4 recorded deaths.

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Underlying cause of death by gender and Aboriginal status, NT, 2009-13

Table 16 shows the UCOD by gender and Aboriginal status for the past five years. Overall, there were more male deaths (134) than female (107) and significantly more Aboriginal (173) than non-Aboriginal (68).

Table 16: Underlying cause of death by ICD-10 chapter, gender and Aboriginal status,

NT, 2009-13

ICD-10-AM chapter description Female Male Aboriginal Non-

Aboriginal

Certain infectious and parasitic diseases 1 (0.9)

3 (2.2)

3 (1.7)

1 (1.5)

Neoplasms 4 (3.7)

1 (0.7)

3 (1.7)

2 (2.9)

Endocrine, nutritional and metabolic diseases 1 (0.9)

1 (0.7)

1 (0.6)

1 (1.5)

Diseases of the nervous system 2 (1.9)

10 (7.5)

10 (5.8)

2 (2.9)

Diseases of the ear and mastoid process

1 (0.7)

1 (0.6)

Diseases of the circulatory system 1 (0.9)

1 (0.7)

2 (1.2)

Diseases of the respiratory system 2 (1.9)

4 (3.0)

5 (2.9)

1 (1.5)

Diseases of the digestive system

1 (0.7)

1 (0.6)

Certain conditions originating in the perinatal period

26 (24.3)

40 (29.9)

46 (26.6)

20 (29.4)

Congenital malformations, deformations and chromosomal abnormalities

11 (10.3)

8 (6.0)

12 (6.9)

7 (10.3)

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

20 (18.7)

15 (11.2)

25 (14.5)

10 (14.7)

External causes of morbidity and mortality 27 (25.2)

42 (31.3)

52 (30.1)

17 (25.0)

Awaiting coronial findings and/or cause of death*

12 (11.2)

7 (5.2)

12 (6.9)

7 (10.3)

Total 107 (100)

134 (100)

173 (100)

68 (100)

Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

External causes of death involved 42 males 27 females. Of these; 11 males and 9 females died as a result of intentional self-harm; 9 males and 7 females were involved in motor vehicle accidents; and 6 males and 1 female drowned.

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Deaths originating in the ‘perinatal period’ as well as those from ‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified’ do not appear to be specifically gender-related.

Of the 241 child deaths in the five year reporting period, 173 (72%) were Aboriginal and 68 (28%) were non-Aboriginal.

Sixty-nine deaths were due to ‘external causes’ of which 52 were Aboriginal and 17 non-Aboriginal children. Of these, 18 Aboriginal and 2 non-Aboriginal deaths were the result of intentional self-harm, 13 Aboriginal and 3 non-Aboriginal children died from motor vehicle-related accidents; and 3 Aboriginal and 4 non-Aboriginal children died from drowning.

Figures 5 and 6 provide a comparison by gender and Aboriginal status for each of the ICD-10-AM Chapters. Males dominated all but 3 of the chapter categories apart from ‘Neoplasms, congenital malformations’ and those yet to be coded. Aboriginal deaths were over represented in all chapter categories with the exception of ‘Endocrine, nutritional and metabolic diseases’, where proportions of both Aboriginal and non-Aboriginals children were equally represented.

Figure 5: Underlying cause of death by ICD-10 chapter and gender, NT, 2009-13

Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

1

4

1

2 1 2

26

11

20

27

12

3

1 1

10

1 1

4

1

40

8

15

7

0

5

10

15

20

25

30

35

40 Female

Male

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Figure 6: Underlying cause of death by ICD-10 chapter and Aboriginal status, NT,

2009-13

Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

3 3 1

10

1 2

5

1

46

12

25

52

12

1 2 1 2 1

20

7

10

17

7

0

5

10

15

20

25

30

35

40

45

50

55 Aboriginal

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Underlying cause of death by ICD-10 chapter and usual residence, NT, 2009-13

Table 17 shows the UCOD by the usual residence of the deceased for the period 2009- 2013 inclusive. Due to the small numbers of deaths in certain areas, usual residence is categorised into the Greater Darwin area versus the Rest of the NT to avoid the possibility of identifying individuals.

Table 17: Underlying cause of death by ICD-10 Chapter and usual residence, NT,

2009-13

ICD-10-AM chapter descriptions Greater Darwin

Rest of the NT

Total

Certain infectious and parasitic diseases 3 (4.1)

1 (0.6)

4 (1.7)

Neoplasms 1 (1.4)

4 (2.4)

5 (2.1)

Endocrine, nutritional and metabolic diseases 2 (2.7)

2 (0.8)

Diseases of the nervous system 3 (4.1)

9 (5.4)

12 (5.0)

Diseases of the ear and mastoid process

1 (0.6)

1 (0.4)

Diseases of the circulatory system

2 (1.2)

2 (0.8)

Diseases of the respiratory system

6 (3.6)

6 (2.5)

Diseases of the digestive system 1 (1.4)

1 (0.4)

Certain conditions originating in the perinatal period 23 (31.5)

43 (25.6)

66 (27.4)

Congenital malformations, deformations and chromosomal abnormalities

6 (8.2)

13 (7.7)

19 (7.9)

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

11 (15.5)

24 (14.3)

35 (14.5)

External causes of morbidity and mortality 15 (20.5)

54 (32.1)

69 (28.6)

Awaiting coronial findings and/or cause of death* 8 (11.0)

11 (6.5)

19 (7.9)

Total 73 (100)

168 (100)

241 (100)

Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

Of the 241 child deaths recorded, 168 (70%) were from the Rest of the NT with 71 (30%) occurring in the Greater Darwin area.

Of the 69 deaths from external causes, 54 were from the Rest of the NT with 15 from the Greater Darwin area. A further break down of these figures reveals 17 intentional self-harm

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deaths; 13 that involved motor vehicles and 5 drownings involved children from the Rest of the NT. Of the deaths from the Greater Darwin area, 3 involved intentional self-harm, 3 involved motor vehicles and 2 involved drowning.

Figure 7 provides a comparison by usual residence status for each of the ICD-10-AM Chapters respectively. It is clear from figure 7 that the greater percentage of child deaths affect children whose usual residence was the Rest of the NT.

Figure 7: Underlying cause of death by ICD-10 chapter and usual residence, NT,

2009-13

Source: NT Child Deaths Register *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

Underlying cause of death by chapter and age group, NT, 2009-13

As indicated in Table 18, 132 (55%) of all child deaths between 2009 and 2013 occurred in the < 1 year age group, followed by 32 (13%) 1-4 years, 17 (7%) 5–9 years, 26 (11%) 10-14 years and 34 (14%) in the 15–17 years category.

The largest number of deaths in the < 1 year age group were from ‘conditions originating in the perinatal period’ (65 or 49.2%), followed by ‘Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified’ (34 or 25.8%), which includes Sudden Infant Deaths (SIDS) or Sudden Unexpected Death in Infancy (SUDI).

The ‘external causes’ chapter includes accidents and injuries and contains most of the potentially preventable causes of death. Over a quarter of all child deaths (28.6%) in the NT occur within this Chapter.

3 1

2 3 1

23

6

11 15

8

1 4

9

1 2 6

43

13

24

54

11

0

5

10

15

20

25

30

35

40

45

50

55

60GreaterDarwin

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Fifteen to seventeen-year-olds accounted for 26 (38%) of all deaths by ‘external causes’, followed by the 10–14 years group with 19 (28%); the 1–4 years group with 14 (20%); the 5-9 years group with 7 (10%); and the < 1 year group with 3 (4%).

Table 18: Underlying cause of death by ICD-10 chapter and age-group, NT, 2009-13

ICD-10-AM chapter descriptions < 1 year 1 - 4

years 5 - 9

years 10 - 14 years

15 - 17 years

Total

Certain infectious and parasitic diseases

2 (1.5)

1 (5.9)

1 (2.9)

4 (1.7)

Neoplasms

3 (17.6)

2 (7.7)

5 (2.1)

Endocrine, nutritional and metabolic diseases

2 (6.3)

2 (0.8)

Diseases of the nervous system 1 (0.8)

2 (6.3)

4 (23.5)

2 (7.9)

3 (8.8)

12 (5.0)

Diseases of the ear and mastoid process

1 (3.1)

1 (0.4)

Diseases of the circulatory system

1 (3.1)

1 (5.9)

2 (0.8)

Diseases of the respiratory system 4 (3.0)

1 (3.1)

1 (2.9)

6 (2.5)

Diseases of the digestive system

1 (3.1)

1 (0.4)

Certain conditions originating in the perinatal period

65 (49.2)

1 (3.1)

66 (27.4)

Congenital malformations, deformations and chromosomal

abnormalities 10

(7.6) 6

(18.8) 1

(5.9) 1

(3.8) 1

(2.9) 19

(7.9) Symptoms, signs and abnormal clinical and laboratory findings,

not elsewhere classified 34

(25.8)

1 (3.8)

35 (14.5)

External causes of morbidity and mortality

3 (2.3)

14 (43.8)

7 (41.2)

19 (73.1)

26 (76.5)

69 (28.6)

Awaiting coronial findings and/or cause of death*

13 (9.8)

3 (9.4)

1 (3.8)

2 (5.9)

19 (7.9)

Total 132 (100)

32 (100)

17 (100)

26 (100)

34 (100)

241 (100)

Source: NT Child Deaths Register proportions may differ from last year’s report due to updated numbers, late registrations etc. *includes 12 deaths which are still open coronial cases and 7 requiring ICD-10-AM coding

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CHAPTER 5

Research

Literature Reviews

In 2014 the Committee commissioned the Menzies School of Health Research to conduct literature reviews into issues related to child deaths in the NT and elsewhere. These include the following topics:

The bullying of young people in communities through the use of Facebook, Twitter,

Instagram, and other forms of social media;

The high number of hospital admissions of females under the age of 18, following

incidents of violence (i.e. self-inflicted or due to assault);

A review of possible causes or contributing factors to the high number of perinatal

deaths in the NT; and

The issue of parental supervision relating to child deaths, to include the monitoring of

children using quad bikes; children ‘roaming the streets’ unsupervised; safety around

storm water drains; and the monitoring of safety relating to electrical cords and power

points.

The decision to commission these literature reviews was made following a number of concerns identified by committee members concerning risk factors that could contribute to the deaths of young people in the NT.

In the 2014-15 financial year the Committee will be evaluating these reviews in the course of developing its research program.

Update on intentional self-harm deaths of NT children, 2011-13

Background

In 2011 the Committee commissioned the Menzies School of Health Research to conduct a study of suicide deaths among children and young people under the age of eighteen years (Robinson, Silburn & Leckning, 2011). This resulted from concerns about the high rate of suicide for young people in the NT.

The study examined 18 suicide deaths for the period 2006 to 2010 with the aim of:

1. Exploring the recent trends and methods in child and youth suicide;

2. Determining if any evidence of clustering existed by geographical area or particular

community groups and the nature of any socially mediated contagion factors; and

3. Establishing the existence of contextual elements such as alcohol and/or drug

misuse close to the event, child protection involvement, educational engagement

levels, mental health interaction or criminal history which might be considered risk

factors to suicide.

As an outcome of the study, the Committee, in its separate report (CDRPC, 2011), made 15 recommendations to government under the following headings:

Preventative Services

Targeted Prevention Services

Policy and Framework Review

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Postvention Services

Trauma, coping mechanisms and self-regulation

Departmental service and coordination of responses to suicides

Developing the evidence base on suicide in the NT.

A public release version of the report, including the recommendations, was presented to Government in early 2012.

The report ‘Suicide of Children and Youth in the NT 2006-2010’ found that the ages of the children ranged between 12 and just under 18 years of age. Eleven were male and there were 7 female, with all but one being Aboriginal. In the majority of cases the deaths occurred in or near the deceased person’s home. A significant number of the deaths occurred shortly after violence or other conflict with family members or partners.

The follow-up review

In conjunction with the NT Coroner’s Office, the Committee has reviewed an additional 17 intentional self-harm deaths involving children and young people that occurred between 2011 and 2013.

The term ‘intentional self-harm’ is used by a coroner to define a death that is a non-accidental, self-inflicted death. This review does not include deaths that were found by the coroner to be accidental.

The study was based on a review of available coronial files and it is believed there were no outstanding coronial cases related to intentional self-harm by children within this time period.

In the following tables, some data is presented on adult self-harm deaths to provide for comparisons of self-harm patterns amongst both children and adults. Table 1 shows child and adult intentional self-harm deaths by usual residential region and Aboriginal status.

In the initial Menzies study, deaths were categorised on the basis of NT Local Government Areas (LGA). For each death the LGA was identified from the suburb using the ABS Australian Standard Geographical Classification (ASGC, 2006). As the Child Deaths Register does not contain the ASGC system, Table 2, which lists self-harm deaths for the years 2011-13 categorises usual residence as either the Greater Darwin area or the Rest of the NT.

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Table 19: Distribution of child and adult intentional self-harm deaths by Aboriginal

status and usual residence, for audited cases, NT, 2006-10

Aboriginal Non-aboriginal

Region Child Adult Child Adult

N % N % N % N %

Greater Darwin 8 47.1% 16 19.5% 0 0.0% 78 81.3%

West Arnhem 1 5.9% 4 4.9% 0 0.0% 1 1.0%

East Arnhem 1 5.9% 16 19.5% 1 100.0% 1 1.0%

Victoria Daly 2 11.8% 3 3.7% 0 0.0% 0 0.0%

Katherine 0 0.0% 3 3.7% 0 0.0% 2 2.1%

Roper Gulf 1 5.9% 2 2.4% 0 0.0% 1 1.0%

Central Desert 0 0.0% 3 3.7% 0 0.0% 0 0.0%

Barkly 1 5.9% 9 11.0% 0 0.0% 1 1.0%

Alice Springs 1 5.9% 12 14.6% 0 0.0% 7 7.3%

McDonnell 2 11.8% 4 4.9% 0 0.0% 0 0.0%

Tiwi Island 0 0.0% 5 6.1% 0 0.0% 1 1.0%

Interstate 0 0.0% 1 1.2% 0 0.0% 0 0.0%

Unknown 0 0.0% 4 4.9% 0 0.0% 4 4.2%

Total 17 100.0% 82 100.0% 1 100.0% 96 100.0% Source: Menzies School of Health Research

In the five years 2006-10, there were 18 child deaths and 178 adult deaths for which the NT Coroner made a finding of intentional self-harm. Of these child deaths, 17 (94%) were Aboriginal and 1 (6%) was non-Aboriginal; in the same period there were 82 (46%) Aboriginal and 96 (54%) non-Aboriginal adults who died as a result of intentional self-harm.

Table 20 shows the child and adult self-harm deaths in the years 2011–13 by usual residence categorised as either Greater Darwin or the Rest of the NT, and by Aboriginal status.

Table 20: Distribution of child and adult intentional self-harm by Aboriginal status and

usual residence, for audited cases, NT, 2011-13

Aboriginal Non-aboriginal

Child Adult Child Adult

Region N % N % N % N % Greater Darwin 2 14.3% 11 20.0% 2 66.7% 36 62.1%

Rest of NT 12 85.7% 44 80.0% 1 33.3% 22 37.9%

Total 14 100.0% 55 100.0% 3 100.0% 58 100.0% Source: Office of the NT Coroner

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It can be seen that in the three years 2011-13 there were 17 child deaths and 113 adult deaths where the NT Coroner made a finding of intentional self-harm. Of these child deaths 14 (82%) were Aboriginal and 3 (17.6%) were non-Aboriginal; amongst the adults, there were 55 (49%) Aboriginal and 58 (51%) non-Aboriginal deaths. A much higher percentage of children who die as a result of intentional self-harm are likely to be Aboriginal.

It can also be seen in Table 2 that 4 (23.5%) children died in the Greater Darwin region whilst 13 (76.5%) died in the Rest of the NT, despite the Greater Darwin Region having a slightly larger child population. For adults, 47 (42%) were from Greater Darwin while 66 (58%) were from the Rest of the NT. Again there are different patterns for children and adults – amongst adults, the distribution of deaths by region more closely aligns with the population distribution.

Table 21 shows child deaths as a result of intentional self-harm by gender and age group.

Table 21: Child deaths by intentional self-harm by gender and age group, NT, 2011-13

Gender 2011 2012 2013 Total

Female 2 1 4 7

Male 1 5 4 10

Total 3 6 8 17

Age

10 - 14 years 1 1 3 5

15 - 17 years 2 5 5 12

Total 3 6 8 17

Source: Office of the NT Coroner

Of the 17 children who died as a result of intentional self-harm, 7 (41%) were female, and 10 (59%) were male. This gender distribution is similar to that found in the 2011 study. Five of the children who died were in the 10-14 age bracket (which covers 5 years), whilst 12 were in the 15-17 age bracket (which covers only 3 years). The youngest child was 10 years of age; 2 were aged 13 years; 2 were aged 14 years; 3 were aged 15 years, 8 were aged 16 years and one was aged 17 years of age. As with the findings of the Committee’s initial study, the majority of deaths occurred in or near the child’s home.

Table 22 shows adult deaths resulting from intentional self-harm by gender and usual residence.

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Table 22: Adult deaths by intentional self-harm, NT, 2011-13

Aboriginal status 2011 2012 2013 Total

Aboriginal 22 16 17 55

Non-Aboriginal 20 21 17 58

Total 42 37 34 113

Gender 2011 2012 2013 Total

Female 4 5 12 21

Male 38 32 22 92

Total 42 37 34 113

Usual residence 2011 2012 2013 Total

Greater Darwin 14 19 14 47

Rest of the NT 28 18 20 66

Total 42 37 34 113 Source: Office of the NT Coroner

It can be seen that females accounted for 21 (18.5%) adult deaths from intentional self-harm and males accounted for 92 (81.5%) deaths. This contrasts with the 7 (41%) female and 10 (59%) male children in Table 21.

There are also significant differences with respect to the places of usual residence. Whereas 76.5 percent of child deaths occurred in the Rest of the NT, 58.5 percent of adult deaths occurred there.

Figure 8 shows the distribution of child deaths as a result of self-harm for the years 2006 to 2013.

Figure 8: Child deaths by intentional self-harm, NT, 2006-13

Source: Office of the NT Coroner

5

6

4

0

3 3

6

8

0

1

2

3

4

5

6

7

8

9

2006 2007 2008 2009 2010 2011 2012 2013

Child deaths by intentional self-harm

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It can be seen that there is significant annual variation in the number of child deaths as a result of intentional self-harm in the period, ranging from 0 in 2009 to 8 in 2013. At this stage it is not possible to determine whether the increasing annual numbers from 2010 represent an underlying trend.

Of the total number (35) of child deaths by intentional self-harm, the annual average was 3.9 for Aboriginal children and .05 for non-Aboriginal children, with an overall average of 4.4 deaths for all children between the ages of 10 and 17 years in this period. This equates to a suicide death rate of 33.4 per 100,000 Aboriginal children and 3.4 per 100,000 for non-Aboriginal children, with an overall rate of 16.7 per 100,000 for children. (ABS.3238.0).

Key points from the review

Child deaths in the NT as a result of intentional self-harm continue to occur at the high rates identified in the 2011 study.

There are significant differences between children and adults with respect to the gender distribution, places of usual residence and Aboriginal status.

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References

Abeywardana, S. & Sullivan, E.A. (2008). Congenital anomalies in Australia 2002–2003. Birth anomalies Series no. 3 Cat. no. PER 41. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit.

Australian Bureau of Statistics, (2014a). Australian Demographic Statistics, Sep 2013.

Estimated Resident Population, States and Territories. ABS. Cat No. 3101.0.

Australian Bureau of Statistics, (2014b). Estimates and Projections, Aboriginal and Torres

Strait Islander Australians, 2001 to 2026: Population Projection B. ABS Cat. No. 3238.0

Australian Bureau of Statistics, (2013) Australian Demographic Statistics, Dec 2013, 1971 to 2013, Cat No.3101.0, June 2014: Canberra.

Australian Bureau of Statistics (2013). Population by Age and Sex, Regions of Australia, Cat No. 3235.0. Aug 2014: Canberra.

CDRPC (2012) Report on Child and Youth Suicide in the NT. Child Deaths Review and Prevention Committee, Darwin.

Condon, J., Barnes, T., Cunningham, J. & Smith, L. (2004) Improvements in Indigenous mortality in the Northern Territory over four decades. Australian and New Zealand Journal of Public Health, 28: 445-451.

Laws, P.J. & Hilder, L. (2008) Australia’s mothers and babies 2006. Perinatal statistics series no. 22.Cat. no. PER 46. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit.

Northern Territory of Australia, Births, Deaths and Marriages Registration Act (as in force at 1 July 2010).

Robinson, G., Silburn, S., Leckning, B., (2011) Suicide of children and youth in the NT, 2006-2010: Public Release Report for the Child Deaths Review and Prevention Committee, Darwin: Menzies Centre for Child Development and Education.

World Health Organisation (2008) ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2 Instruction Manual, 33-34.

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Appendix 1: Northern Territory of Australia Care and Protection of Children Act Part

3.3 - Prevention of Child Deaths

207 Object of Part

The object of this Part is to assist in the prevention and reduction of child deaths through:

(a) maintaining a database on child deaths; and

(b) conducting research about child deaths, and diseases and accidents involving children; and

(c) the development of appropriate policy to deal with such deaths, diseases and accidents.

208 Child deaths

A child death is:

(a) the death of a child who usually resided in the Territory (whether the death occurred in the Territory or not); or

(b) a still-birth as defined in the Births, Deaths and Marriages Registration Act that occurred in the Territory.

209 Establishment of Committee

(1) There is to be a Child Deaths Review and Prevention Committee.

(2) The Committee consists of at least 10 but not more than 16 members.

(3) Each member must be:

(a) someone who has qualifications or experience relating to the functions of the Committee; and

(b) appointed by the Minister in writing for a term not exceeding 2 years.

(4) The Minister must:

(a) appoint one member to be the Convenor of the Committee; and

(b) appoint another member to be the Deputy Convenor of the Committee.

(5) At least 2 members must be Aboriginal persons.

(6) One member must be a deputy coroner nominated by the Territory Coroner for this section.

(7) A member is eligible for re-appointment.

(8) In this section:

deputy coroner means a deputy coroner as defined in the Coroners Act.

Territory Coroner means the Territory Coroner as defined in the Coroners Act.

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210 Functions of Committee

The Committee has the following functions:

(a) to establish and maintain the Child Deaths Register;

(b) to conduct or sponsor research into child deaths, diseases and accidents involving children, and other related matters (such as childhood morbidity and mortality), whether alone or with others;

(c) to raise public awareness about a matter mentioned in paragraph (b), including, for example, any of the following:

(i) the death rates of children;

(ii) the causes and nature of child deaths and of diseases and accidents involving children;

(iii) the prevention or reduction of such deaths, diseases and accidents;

(d) to make recommendations about a matter mentioned in paragraph (b);

(e) to monitor the implementation of the recommendations;

(f) to contribute to any national database on child deaths in Australia;

(g) to enter into an arrangement for the sharing of information with anyone in Australia that has functions similar to those of the Committee;

(h) to perform any other functions relating to the object of this Part as the Minister directs.

211 Provision of information to Committee

(1) Any of the following persons must, on the Committee's request, give specified information to the Committee for any of its functions:

(a) the Commissioner of Police;

(b) the Registrar of Births, Deaths and Marriages;

(c) a coroner;

(d) a service provider for a protected child;

(e) a health practitioner;

(f) a person in charge of a facility for health services in which children are ordinarily patients;

(g) an operator of child-related services;

(h) an operator of children's services.

Maximum penalty: 200 penalty units or imprisonment for 2 years.

(2) It is a defence to a prosecution for an offence against subsection (1) if:

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(a) the defendant has a reasonable excuse; or

(b) the Commissioner of Police certifies in writing that compliance with the request would:

(i) prejudice the investigation of any unlawful conduct; or

(ii) disclose a confidential source of information in relation to the administration of law; or

(iii) prejudice the effectiveness of a method or procedure in relation to the administration of law; or

(iv) facilitate a person's escape from lawful custody; or

(v) endanger the safety of a person.

(3) A person acting in good faith in giving information to the Committee is not civilly or criminally liable, or in breach of any professional code of conduct, for giving the information.

212 Child Deaths Register

(1) There is to be a Child Deaths Register.

(2) The Register is a database of information concerning child deaths.

(3) Without limiting subsection (2), the Register may include information on:

(a) incidences of child deaths; and

(b) the causes, patterns and trends of child deaths.

213 Annual Report

(1) At the end of each financial year, the Committee must prepare a report about the operation of the Committee during that year.

(2) The report must contain details about:

(a) the Committee's activities during that year, including:

(i) the development of the Register during that year; and

(ii) any recommendations made by the Committee during that year; and

(b) the implementation during that year of any recommendations made by the Committee.

(3) The Committee must, by 31 October following the end of that year, give the report to the Minister.

(4) The Minister must table a copy of the report in the Legislative Assembly within 6 sitting days after receiving the report.

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214 Report about research

(1) The Committee may prepare reports about research conducted or sponsored by the Committee (whether alone or with others).

(2) The Committee must give the reports to the Minister.

(3) The Minister must table a copy of each of the reports in the Legislative Assembly within 6 sitting days after receiving the report.

215 Advisors to Committee

(1) The Minister may, on the Convenor's recommendation, appoint persons to be advisors to the Committee.

(2) The Convenor may only recommend a person who has qualifications or experience relating to:

(a) a function of the Committee; or

(b) health care, child development or protection, or research methodology.

(3) An advisor may be appointed for:

(a) the duration of a project specified in the appointment; or

(b) a term not exceeding 2 years specified in the appointment.

(4) An advisor is eligible, on the recommendation of the Convenor, for re-appointment.

(5) An advisor must assist the Committee in performing the Committee's functions as specified in the appointment.

(6) Without limiting subsection (5), the appointment may specify that the advisor must conduct specified research.

216 Deputy Convenor

The Deputy Convenor must act in the office of Convenor if:

(a) the Convenor is unable to exercise the Convenor's powers or perform the Convenor's functions; or

(b) the office of Convenor is vacant.

217 Vacation of office of member or advisor

A member or advisor vacates his or her office if:

(a) the term of the appointment of the member or advisor expires; or

(b) the member or advisor resigns the office in writing given to the Minister; or

(c) the appointment is terminated under section 218; or

(d) the member or advisor dies.

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218 Termination of appointment

(1) The Minister must terminate a person's appointment as a member or advisor if:

(a) the person contravenes section 221; or

(b) for a person appointed as a member:

(i) the person has been absent (except on leave granted by the Minister) from 3 consecutive meetings of the Committee; or

(ii) the person contravenes section 220.

(2) In addition, the Minister may terminate the appointment:

(a) on the ground of misbehaviour; or

(b) on the ground the person becomes physically or mentally incapable of satisfactorily performing the duties of the appointment.

(3) Furthermore, the appointment is terminated if:

(a) the person:

(i) becomes bankrupt; or

(ii) applies to take the benefit of a law for the relief of bankrupt or insolvent debtors; or

(iii) compounds with creditors or makes an assignment of the person's remuneration for their benefit; or

(b) is found guilty by a court in the Territory of an offence punishable by imprisonment for 12 months or more; or

(c) is found guilty by a court outside the Territory of an offence which, if committed against a law of the Territory, would be an offence punishable by imprisonment for 12 months or more.

(4) A termination under subsection (1) or (2) must be by writing given to the person.

219 Meetings of Committee

(1) The Committee must meet at least 3 times in each year.

(2) In a meeting of the Committee, the number of members that is equal to half of the members plus one constitutes a quorum.

(3) A meeting of the Committee must be presided by:

(a) the Convenor; or

(b) in the absence of the Convenor – the Deputy Convenor; or

(c) in the absence of both the Convenor and the Deputy Convenor – a member elected by the members present at the meeting.

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220 Disclosure of interest

(1) A member who has a direct or indirect interest in a matter to be considered by the Committee must disclose the interest to the Committee.

(2) The disclosure must be recorded in the Committee's minutes.

(3) The member:

(a) must not take Part in any deliberation or decision of the Committee about the matter; and

(b) must be disregarded for the purposes of constituting the quorum of the Committee for the deliberation or decision.

(4) The Committee may decide subsection (3) does not apply to the matter.

(5) However, the decision must be deliberated and voted on in the absence of the member.

221 Confidential information

(1) A person who has acquired information in exercising a power or performing a function under this Part is guilty of an offence if the person:

(a) discloses the information to someone; or

(b) does something that results in disclosing the information to someone and is reckless as to whether doing the thing would result in the disclosure; or

(c) uses the information.

Maximum penalty: 200 penalty units or imprisonment for 2 years.

(2) Subsection (1) does not apply to:

(a) a disclosure or use of the information by a person in exercising a power or performing a function under this Part; or

(b) a disclosure or use of the information for any of the following purposes authorised by the Minister:

(i) research relating to the object of this Part;

(ii) an inquiry or investigation conducted by a coroner, the Police Force or another law enforcement agency;

(iii) a purpose specified by regulation; or

(c) a disclosure of the information to a court or tribunal; or

(d) a disclosure or use of the information that is otherwise required or authorised by law.

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222 Review of operation of Part

(1) The Minister must conduct a review of the operation of this Part within 3 years after the commencement of this Part.

(2) The review must determine:

(a) the extent to which the operation of this Part has met the object of this Part; and

(b) whether or not any amendment to this Part should be made.

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Appendix 2: Infant mortality rate by Aboriginal status and year, NT, 1992–12

Source: ABS 33020D018_2012 # Rates per 1000 live births

While single year Aboriginal rates may fluctuate due to small numbers, they are nevertheless a reliable indicator when viewed as a trend over many years. Appendix 2 shows the rate ratio of Aboriginal to non-Aboriginal infant mortality rates over the past two decades. The results show that on average, the Aboriginal rates are approximately 3 times greater than the non-Aboriginal rates.

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Appendix 3: Table of underlying cause of child deaths by ICD-10 chapters, NT,

2009-13

Chapter 1: Certain infectious and parasitic diseases (A00 - B99) 4

Sepsis due to Streptococcus pneumoniae 1 Staphylococcus aureus as the cause of diseases classified to other chapters 1 Unspecified viral encephalitis 1 Viral carditis 1

Chapter 2: Neoplasms (C00 - D48) 5

Malignant neoplasm of brain stem 1 Malignant neoplasm of kidney, except renal pelvis 1 Malignant neoplasm of ovary 1 Malignant neoplasm of pineal gland 1 Malignant neoplasm of submandibular gland 1

Chapter 4: Endocrine, nutritional and metabolic diseases (E00 - E99) 2

Disorders of copper metabolism 1 Volume depletion 1

Chapter 6: Diseases of the nervous system (G00 - G99) 12

Cerebral palsy, unspecified 2 Dyskinetic cerebral palsy 1 Epilepsy, unspecified, with intractable epilepsy 1 Localisation-related (focal)(partial) idiopathic epilepsy and epileptic syndromes with

seizures of localised onset, without mention of intractable epilepsy 1 Muscular dystrophy 2 Sequelae of inflammatory diseases of central nervous system 1 Spastic cerebral palsy, unspecified 1 Spastic quadriplegic cerebral palsy 3

Chapter 8: Diseases of the ear and mastoid process (H60 - H95) 1

Other chronic suppurative otitis media 1

Chapter 9: Diseases of the circulatory system (I00 - I99) 2

Acute rheumatic heart disease, unspecified 1 Infective pericarditis 1

Chapter 10: Diseases of the respiratory system (J00 - J99) 6

Bronchopneumonia, unspecified 2 Pneumonia, unspecified 1 Respiratory disorder, unspecified 1 Viral pneumonia, unspecified 2

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Chapter 11: Diseases of the digestive system (K00 - K99) 1

Acute appendicitis with generalised peritonitis 1

Chapter 16: Certain conditions originating in the perinatal period (P00 - P96) 66

Congenital cytomegalovirus infection 1 Disseminated intravascular coagulation of fetus and newborn 1 Extreme immaturity, 24 or more completed weeks but less than 28 completed weeks 6 Extreme immaturity, less than 24 completed weeks 7 Extremely low birth weight 499g or less 5 Extremely low birth weight 500 - 749g 1 Extremely low birth weight 750 - 999g 1 Fetus and newborn affected by chorioamnionitis 8 Fetus and newborn affected by incompetent cervix 3 Fetus and newborn affected by maternal hypertensive disorders 1 Fetus and newborn affected by other forms of placental separation and haemorrhage 1 Fetus and newborn affected by other malpresentation, malposition and disproportion

during labour and delivery 1 Fetus and newborn affected by other maternal conditions 1 Fetus and newborn affected by other specified complications of labour and delivery 2 Fetus and newborn affected by premature rupture of membranes 7 Hypoxic ischaemic encephalopathy [HIE] of newborn 1 Intracerebral (nontraumatic) haemorrhage of fetus and newborn 1 Intraventricular (nontraumatic) haemorrhage, grade 3 and grade 4, of fetus and

newborn 1 Invasive neonatal candidiasis 1 Necrotising enterocolitis of fetus and newborn 5 Other specified conditions originating in the perinatal period 1 Perinatal intestinal perforation 1 Prematurity, unspecified 2 Respiratory distress syndrome of newborn 1 Sepsis of newborn due to streptococcus, group B 1 Severe birth asphyxia 1 Termination of pregnancy, affecting fetus and newborn 2 Unspecified intraventricular (nontraumatic) haemorrhage of fetus and newborn 1 Unspecified pulmonary haemorrhage originating in the perinatal period 1

Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00 - Q99) 19

Agenesis of corpus callosum 1 Aortopulmonary septal defect 1 Edwards' syndrome, unspecified 1 Gastroschisis 1 Hydranencephaly 1 Hypoplasia and dysplasia of lung 1

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Microcephaly 1 Osteogenesis imperfecta 1 Other specified congenital malformation syndromes predominantly affecting facial

appearance 1 Other specified congenital malformation syndromes, not elsewhere classified 1 Other specified congenital malformations of brain 1 Other specified congenital malformations of intestine 1 Other specified trisomies and partial trisomies of autosomes 1 Pierre Robin sequence 1 Sirenomelia syndrome 1 Tetralogy of Fallot 1 Total anomalous pulmonary venous connection 1 Tuberous sclerosis 2

Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00 - R99) 35

Death occurring less than 24 hours from onset of symptoms, not otherwise explained 1 Other ill-defined and unspecified causes of mortality 28 Sudden infant death syndrome 3 Sudden infant death syndrome with mention of autopsy 2 Unattended death 1

Chapter 20: External causes of morbidity and mortality (V00 - V99) 69

Accident to other private fixed-wing aircraft, injuring occupant 2 Accidental suffocation and strangulation in bed 1 Assault by hanging, strangulation and suffocation, parent 2 Assault by sharp object, unspecified, spouse or domestic partner 1 Assault by smoke, fire and flames, unspecified person 1 Bitten or struck by crocodile or alligator 4 Car occupant injured in collision with car, pick-up truck or van, passenger, traffic

accident, sedan 1 Car occupant injured in collision with fixed or stationary object, passenger, traffic

accident, all-terrain four-wheel drive 2 Car occupant injured in non-collision transport accident, driver, traffic accident, other

specified car [automobile] 1 Car occupant injured in non-collision transport accident, driver, traffic accident, sedan 1 Car occupant injured in non-collision transport accident, passenger, traffic accident,

sedan 5 Car occupant injured in non-collision transport accident, passenger, traffic accident,

unspecified car [automobile] 1 Driver of all-terrain or other off-road motor vehicle injured in non-traffic accident,

four-wheeled special all-terrain or other off-road motor vehicle 1 Drowning and submersion following fall into natural water 2 Drowning and submersion following fall into swimming-pool 2 Drowning and submersion while in natural water 1

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Drowning and submersion while in swimming-pool 1 Exposure to uncontrolled fire in building or structure 1 Exposure to unspecified factor 1 Fall involving cot 1 Hanging, strangulation and suffocation, undetermined intent 2 Inhalation and ingestion of food causing obstruction of respiratory tract 2 Inhalation and ingestion of other objects causing obstruction of respiratory tract,

other specified object 1 Intentional self-harm by hanging 20 Occupant of pick-up truck or van injured in non-collision transport accident, driver,

traffic accident 1 Other accidental hanging and strangulation 4 Other and unspecified water transport accidents, other powered watercraft 1 Other specified drowning and submersion 1 Pedestrian injured in collision with car, pick-up truck or van, non-traffic accident 1 Pedestrian injured in collision with car, pick-up truck or van, traffic accident 1 Pedestrian injured in collision with heavy transport vehicle or bus, non-traffic accident 1 Striking against or struck by other objects 1 Unspecified threat to breathing 1

Not yet coded 19

Awaiting coronial findings 12 Awaiting cause of death coding 7

Grand Total 241

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Appendix 4: The historical context of NT data on child deaths

The Committee holds child death data from 2006. In order to provide an historical and national context it is necessary to draw data from other sources such as ABS and Health Gains Planning Branch in the DoH. In presenting this data it allows the Committee’s data to be placed in a longer term perspective. This provides a context in which to interpret more recent trends of child death rates.

In terms of population, the NT is the smallest Australian jurisdiction with an estimated population, in 2012, of 235,881 (ABS 2014a). This represents around 1% of the Australian total. The NT has the youngest population in Australia with a median age of 31.5 years. The NT child population, aged less than 18 years, represents 26.7% (62,965) of the total NT population. Approximately 30% (69,976) of the total NT population and 42.3% (26,677) of the NT child population are Aboriginal Australians (ABS, 2014a & 2014b). The NT Aboriginal population is 10.2% of the national Aboriginal and Torres Strait Islander population (684,017).

For children under 18 years, NT death rates have decreased by approximately 90% during the 40 year period from 1967 to 2006. In the same period the corresponding Australian rate declined by approximately 70%. Even though they have seen a greater decline the rates for Aboriginal children remain well above the Australian rates. The NT non-Aboriginal rate has been similar to the overall Australian rates during the last 20 years for both males and females.

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Figure 9: Mortality rates of children aged 1–17 years by gender and Aboriginal status,

NT and Australia, 1967–2006

6.4

non-Indigenous

Australia

Indigenous

58.0

12.90

100

200

300

400

Ra

te p

er 1

00

,00

0

Years

FEMALE

17.8

non-Indigenous

Australia

Indigenous

16.6

39.2

0

100

200

300

400

Ra

te p

er 1

00

,00

0

Years

MALE